CNS agents

Question 1

Enzyme inducers

Answer 1

Rifampin
Phenytoin
Phenobarbital
Carbamazepine
Nafcillin
Alcohol
St. John’s wort

Question 2

Enzyme inhibitors

Answer 2

Erythromycin
Cimetidine
Ciprofloxacin 
Fluconazole 
Ketoconazole
Itraconazole
Clarithromycin
Amiodarone
Grapefruit juice

Question 3

Antidepressants BB warning

Answer 3

Increased risk of suicidal thoughts and behavior

Question 4

Desipramine
Nortriptyline
Amitriptyline
Imipramine
Doxepin
Tri-cyclic Antidepressants

Answer 4

Medications take weeks to work!

Question 5

Amitriptyline

Answer 5

Dosing:

Elderly patients: start at half the dose

Question 6

Monoamine Oxidase Inhibitors
Phenelzine
Isocarboxazid
Tranylcypromine
Selegiline

Answer 6

Avoid OTC decongestants

Wash out period

Question 7

Paroxetine

Answer 7

Pregnancy Category D

Question 8

Venlafaxine

Answer 8

Monitor BP

Question 9

Bupropion

Answer 9

Smoking cessation, Alternative if experiencing sexual side effects from other agents

Question 10

Nefazodone

Answer 10

Priapism

Question 11

Trazodone

Answer 11

Often used as a hypnotic

Take with food

Question 12

Butalbital with Caffeine and Acetaminophen

Answer 12

Report HA that persists for more than 3-4 days

Question 13

5-HT Receptor Agonists “Triptans”

Answer 13

“Standard of care” in the treatment of acute migraine

Question 14

Sumatriptan

Answer 14

injection

Question 15

GABA

Answer 15

inhibitory neuro excitory transmitter

Question 16

phenytoin dosing considerations

Answer 16

Hypo-albuminemia

ALBUMIN- Low albumin will increase phenytoin (higher free levels= more adverse effects)

Question 17

phenytoin reactions

Answer 17

nystagmus (involuntary eye movement)

Decreases efficacy of oral contraceptives

Question 18

carbamazepine

Answer 18

diplopia
Auto-inducer (induces its own metabolism)
Stevens Johnson Syndrome (SJS)

Question 19

Valproic acid

Answer 19

weight gain, alopecia, blurry vision

avoid in young women

Question 20

oxcarbazepine

Answer 20

Consider alternative/additional BC

Is not an auto-inducer

Question 21

lamotrigine

Answer 21

Black box warning – risk of life threatening rash

Question 22

lithium

Answer 22

mood stabilizer

Caution use of diuretics, NSAIDs, ACE-I’s, ARBs

Question 23

Atypical Anti-psychotic agents

Answer 23

Have become 1st line or standard of therapy

Question 24

Atypical agents BBW

Answer 24

Tight glycemic control for all agents- hyperglycemia (diabetes)

Question 25

Aripiprazole

Answer 25

Hyperglycemia, drug induced diabetes mellitus

Question 26

olanzapine

Answer 26

weight gain | Weight gain can lead to diabetes mellitus

Question 27

quetiapine- seroquel

Answer 27

Hyperglycemia, drug-induced diabetes mellitus, EPRs

Question 28

risperidone

Answer 28

Hyperglycemia | May prolong QT interval- Associated with Arrhythmias

Question 29

Benzodiazepines

Answer 29

CNS effects Avoid alcohol consumption Schedule IV medication

Question 30

Buspirone

Answer 30

Non-benzodiazepine anti-anxiety agent Eldery patience to use half the dose Effects of drug may take time (> 1 week) Do not abruptly stop the drug

Question 31

Alzheimer’s Disease

Answer 31

``` Causes: Deficiency in acetylcholine (neurotransmitter Poor prognosis Degeneration of brain tissue Atrophy occurs Medications are not curative ```

Question 32

Donepezil

Answer 32

Bedtime dosing

Question 33

Memantine

Answer 33

hallucinations)

Question 34

Parkinson’s Disease

Answer 34

A deficiency of dopamine in the basal ganglia

Question 35

Carbidopa/Levodopa

Answer 35

Levodopa circulates in plasma to the blood brain barrier then converted to dopamine Carbidopa inhibits breakdown of levodopa which increases the amount of levodopa at the BBB

Question 36

Ropinirole

Answer 36

Monitor blood pressure (orthostatic)

Question 37

Sleep Inducing Agents

Answer 37

Gradual taper upon discontinuation to prevent rebound, relapse or withdrawal symptoms

Question 38

Temazepam

Answer 38

Elderly patients should be started on lower doses

Question 39

Varenicline

Answer 39

Black box warning: depression, suicidal thoughts Pharmacist counseling points: Family members should be aware of mood/suicide thoughts

Question 40

Amphetamine/Dextroamphetamine

Answer 40

Cardiac effects, drug abuse/dependency Growth suppression, psychiatric imbalance Aggression, seizures, visual disturbances Avoid doses close to bedtime Drug holidays – children For catch up growth

Question 41

Methylphenidate

Answer 41

``` Avoid doses close to bedtime Drug holiday (children) ```